One-time screening of most U.S. adults for the hepatitis C virus (HCV) would significantly improve health and survival rates among people living with the virus, but only if there are systems in place to link those who test positive to necessary care and treatment. This is the conclusion of a new paper published online ahead of print by Clinical Infectious Diseases and summarized by Medpage Today.
The report, authored by scientists at the University of Washington in Seattle, is the second in recent months to highlight advantages associated with expanded HCV testing. According to an analysis presented by researchers at the 62nd annual meeting of the American Association for the Study of Liver Diseases (AASLD) in San Francisco in November, testing all individuals born between 1945 and 1965—not just those perceived to be at risk for the infection, as is the current practice—would help identify more than 800,000 people living with the virus, or roughly 86 percent of those who are infected and at risk for potentially fatal liver disease but don’t yet know it.
The more recent paper reiterates the value of expanded HCV testing, while adding that universal screening along—without linkage to care and treatment—would only have a limited impact on illness and death rates.
According to a mathematical model of hepatitis C infections in the U.S. based on ideal rates of referral, treatment and care, the University of Washington team found that flatly screening 60 percent of the U.S. population—those between 20 and 69 years of age—resulted in 7.1 percent fewer deaths than risk-based testing.
However, if one looked at the effects of screening alone—without linking it to measures to see that those who test positive receive treatment—the results were less beneficial, showing only a one percent reduction in mortality for every 15 percent of the population screened. "We need a large-scale, coordinated effort to identify people with this infection and make sure they get the care they need," said study co-author Phillip Coffin, MD.
Currently, the Centers for Disease Control and Prevention (CDC) recommends antibody screening only of individuals with health or lifestyle indicators suggesting potential infection. These indicators include a history of injecting drugs, having a blood transfusion before 1992 or being a chronic hemodialysis patient. Unfortunately, many people living with hepatitis C continue to fall through the cracks, given that they may be uncomfortable disclosing risks—or may have forgotten about high-risk behaviors decades earlier-or have health care providers who lack the time and resources to conduct risk assessments.